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Drug exposures in donor milk: protecting our most vulnerable infants

Journal of Perinatology (2026)Cite this article

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Mother’s own milk (MOM) remains the gold standard of nutrition for high-risk infants, offering unmatched protection and lifelong health benefits [1]. Yet, despite their determination, many mothers struggle to meet their lactation goals. The reality is sobering: as many as 70% of mothers of very low birth weight (VLBW) infants cannot produce enough milk during the NICU stay. The reasons are multifactorial, ranging from maternal health complications, long separations from their infants, the burden of prolonged pumping, and numerous social and structural challenges, such as lack of access to resources and lactation support [2, 3].

Fortunately, when MOM is insufficient, pasteurized donor human milk (PDHM) provides a critical lifeline and often serves as a bridge until MOM can provide adequate amounts of milk. Though not as rich in some bioactive compounds as MOM, PDHM still offers robust protection. Evidence continues to grow—most strikingly, the 2024 Cochrane systematic review of 2296 VLBW infants, which found that PDHM reduces the risk of necrotizing enterocolitis (NEC) in half [4]. For fragile preterm infants, this may be the difference between life and death.

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References

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Authors and Affiliations

  1. Department of Pediatrics, Icahn School of Medicine at Mount Sinai, York City Health + Hospitals Elmhurst, Elmhurst, NY, USA

    Lawrence Noble

  2. Department of Pediatrics, NYC Health + Hospitals Kings County, SUNY-Downstate College of Medicine, Brooklyn, NY, USA

    Ivan Hand

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  1. Lawrence Noble
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  2. Ivan Hand
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Contributions

LN conceived the commentary and drafted the initial manuscript. IH contributed to critical revisions for important intellectual content. Both authors reviewed and approved the final manuscript and agree to be accountable for all aspects of the work.

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Correspondence to Lawrence Noble.

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Noble, L., Hand, I. Drug exposures in donor milk: protecting our most vulnerable infants. J Perinatol (2026). https://doi.org/10.1038/s41372-026-02575-3

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